The long-term cost of incarcerating the nation’s youth is between $8 and $21 billion, according to a report out Tuesday. The Justice Policy Institute’s “Sticker Shock: Calculating the Full Price Tag for Youth Incarceration” says Florida’s base cost is $55,000 dollars per juvenile per year. From there, the number increases. According to the Justice Police Institute’s executive director, Marc Schindler, the total cost of detaining juveniles is about more than running juvenile detention centers. It also includes lost future earnings, tax payments from confined youth, future reliance of formerly confined youth on public assistance. Previous studies suggest that kids locked up for minor crimes might go down a worse path; the incarceration of youth increases the likelihood that they will commit new offenses, and this Justice Policy study considers the costs of those harmed by these new offenses.

Juvenile Detention: Its costs go beyond the costs of running the detention facility.

The eating disorder sufferer, whether female or male will often have a complex array of symptoms. Sometimes they will fit neatly into the Anorexic or Bulimic spectrum, and other times may exhibit symptoms of both, or have other complicated patterns of beliefs about food and their weight. Recent studies over the last decade, on both small and large scale show that as many as fifty percent of all eating disorder sufferers may be likely to have some form of problem with substance abuse or drug addiction too.

The link between eating disorder and substance abuse

When someone is suffering from an eating disorder their symptoms will be such that no matter how hard they try, what they see in the mirror is never good enough, they may view themselves as holding too much weight and whatever the scales say, they will be lying. In a person who is addicted to drugs or other substances, they may feel that they have no control over the stress in their lives or that they simply cannot cope with every day challenges. By taking whatever their substance of choice is, they perceive, albeit wrongly, that it gives them a sense of calm and ease and so they feel more able to cope. The coping mechanism of someone with anorexia, bulimia or EDNOS is similar by nature, the sufferer using either restriction of food or binge eating as a way to cope with their mental troubles. Thus in some cases, the sufferer may turn to substances as a way of trying to deal with their frustrations. It is believed that the condition is more likely to affect people who suffer with bulimia rather than anorexia, though not totally exclusively.

Which comes first?

It’s also important to examine the way in which either condition develops. In some sufferers the eating disorder will present itself first, with the onset of substance abuse following. In such cases, the sufferer may begin to experiment with drugs as a way of firstly suppressing the appetite, secondly as a way of keeping themselves going for long periods of time without eating and thirdly as a way of keeping anxiety and any psychological distress to a minimum. In other cases, the reverse might happen – the sufferer of a drug addiction finding that when they start to withdraw from substances that their appetite and hunger signals become confused which can then lead on to problems with food and either restrictive eating or binging developing.

Eating disorders as an addiction

It’s true to say that in many cases an eating disorder is an addiction in itself. In cases of anorexia and bulimia the sufferer will become addicted to trying to control their weight and try to control what they consume on a daily basis. Sufferers will be affected entirely by genetics, what they see in their immediate environment, how friends and family behave around food and perhaps any traumas or difficulties they have experienced in their lives. All this will create grounding for the development of eating problems and the potential for an issue with drugs or other substances to develop. However, in situations like these it is important to remember that they can be overcome.

Repairing and recovering

It is completely possible to make a recovery from both eating disorders and substance abuse. Finding drug addiction help in Maryland or any other state across the country is something that is incredibly important, alongside treatment for issues with food. Anyone who suffers from both addiction and an eating disorder is fighting two different challenges of dependence, first with food and secondly with the substances. Therapy and inpatient care can go a long way in helping the sufferer understand why they are engaging in certain behaviors and aid them in coming to terms with withdrawal and recovery from both conditions. The first and most important step is for the sufferer to admit they have problems. Once they have been honest and opened up, then the path to wellness can begin in earnest. Sufferers more often than not will find that occasional relapses occur, but it is important to understand that this is entirely normal and all part of the recovery process as a whole. There is nothing to feel afraid or ashamed of in opening up and talking about such issues, being honest and open is a sign of strength and one of wanting to fight and regain health and sufferers must always try and keep this uppermost in their thoughts whilst in recovery.

LOS ANGELES, March 19, 2012 — /PRNewswire/ — Along with countless professionals and families dealing with the physical, emotional and financial consequences of eating disorders, I am deeply disturbed by the way your recent program, “Dying to Be Thin: Meet the Skinniest Women in America,” had the unintended effect of glamorizing the deadliest of all mental illnesses. Rather than documenting the tragedy associated with eating disorders and providing encouragement to sufferers to seek help, you perpetuated myths about the disease and provided harmful information to millions. I believe this show did more harm than good. As a physician, you have a responsibility to improve your coverage of eating disorders in future shows.

“Dying to Be Thin,” while tantalizing, serves to perpetuate one of the deadliest misconceptions about eating disorders. People with eating disorders are not necessarily “skinny” or “thin,” and certainly not everyone who dies from an eating disorder is underweight. In fact, many people die at a very normal weight, especially if they have bulimia. You mentioned on your show that the “more acute cases” were the “thinner” women. That myth is also dangerous to disseminate. Those who weigh less than others are not necessarily “more acute” than others at a “healthy weight.” That misconception has long created stigmas associated with eating disorder sufferers and has often led to under-treatment by physicians who think that because a woman is not thin, she is not as acute. Your focus on thinness did a grave disservice by failing to educate your audience scientifically about what eating disorders really look like.

In giving air time to the Pro-Ana movement, you referred to it as “a dangerous new trend that helps women be skinny at any cost.” The Pro-Ana movement is not new. Pro-Ana (and Pro-Mia) sites have been around since the dawn of the Internet. Far from being “trendy,” they are a very dangerous facet of an eating disorder underground that preys on the mentally ill. Had you consulted an eating disorders expert, you would never have offered your audience direct access to the websites and their images. Studies show that doing so causes harm. One study, on college-aged women (none of whom had eating disorders), discovered that after viewing pro-eating disorders websites, 84% reduced their calorie intake by more than 2,000 calories per week. Only 56% of the women realized they were eating less. Results of the study also indicated that the women exposed to the pro-eating disorders website had decreases in self-esteem and perceived attractiveness.

My days are spent in and out of federal courts battling insurance companies that deny benefits for seriously ill women and men who seek adequate treatment for their diseases – even though a federal law and many state laws mandate that insurers provide similar levels of treatment for mental illnesses as they provide for physical illnesses. Shows such as the one you aired trivialize this disease and undermine the progress well-respected groups such as the International Association for Eating Disorders Professionals, the Eating Disorders Coalition, the National Eating Disorders Association, and the Binge Eating Disorder Association have achieved. Still, getting the national media to take eating disorders seriously without parading dangerously thin women across the television screen is about as difficult as getting an insurance company to pay for a therapeutic length of stay at a residential treatment facility.

It is hard for me to believe that either you or your staff did any legitimate research about eating disorders before planning the programs. Were you aware that professionals in the eating disorder field were in touch with producers at your show in recent months offering the benefits of their expertise free of charge should you plan to air segments about eating disorders? Those calls and e-mails appear to have been ignored.

You owe it to your many viewers to correct the harm your recent program caused. First, please remove all material from your website and blog that mentions the Pro-Ana movement. Second, work with some of the many excellent professionals at reputable facilities around the country to plan follow up segments to properly educate your audience about how people can recover from eating disorders and lead productive and fulfilled lives not centered on food. You have an opportunity to teach millions across the country, including other physicians who might watch your show, the real skinny about eating disorders. I hope you will do the right thing.

About Lisa S. Kantor

Lisa S. Kantor, a Los Angeles lawyer and member of the Board of Directors of the Eating Disorders Coalition, is the country’s premier legal advocate for patients with eating disorders who have been denied health insurance benefits for treatment. In 2011, the 9th U.S. Circuit Court of Appeals ruled for her client in Harlick v. Blue Shield, creating one of the most influential decisions ever in mental health parity litigation and paving the way to making treatment and recovery for severe mental illnesses more attainable. For more information, go to www.kantorlaw.net.

Ashley Judd’s ‘puffy’ appearance sparked a viral media frenzy. But, the actress writes, the conversation is really a misogynistic assault on all women.

The Conversation about women’s bodies exists largely outside of us, while it is also directed at (and marketed to) us, and used to define and control us. The Conversation about women happens everywhere, publicly and privately. We are described and detailed, our faces and bodies analyzed and picked apart, our worth ascertained and ascribed based on the reduction of personhood to simple physical objectification. Our voices, our personhood, our potential, and our accomplishments are regularly minimized and muted.

As an actor and woman who, at times, avails herself of the media, I am painfully aware of the conversation about women’s bodies, and it frequently migrates to my own body. I know this, even though my personal practice is to ignore what is written about me. I do not, for example, read interviews I do with news outlets. I hold that it is none of my business what people think of me. I arrived at this belief after first, when I began working as an actor 18 years ago, reading everything. I evolved into selecting only the “good” pieces to read. Over time, I matured into the understanding that good and bad are equally fanciful interpretations. I do not want to give my power, my self-esteem, or my autonomy, to any person, place, or thing outside myself. I thus abstain from all media about myself. The only thing that matters is how I feel about myself, my personal integrity, and my relationship with my Creator. Of course, it’s wonderful to be held in esteem and fond regard by family, friends, and community, but a central part of my spiritual practice is letting go of otheration. And casting one’s lot with the public is dangerous and self-destructive, and I value myself too much to do that.

However, the recent speculation and accusations in March feel different, and my colleagues and friends encouraged me to know what was being said. Consequently, I choose to address it because the conversation was pointedly nasty, gendered, and misogynistic and embodies what all girls and women in our culture, to a greater or lesser degree, endure every day, in ways both outrageous and subtle. The assault on our body image, the hypersexualization of girls and women and subsequent degradation of our sexuality as we walk through the decades, and the general incessant objectification is what this conversation allegedly about my face is really about.

A brief analysis demonstrates that the following “conclusions” were all made on the exact same day, March 20, about the exact same woman (me), looking the exact same way, based on the exact same television appearance. The following examples are real, and come from a variety of (so-called!) legitimate news outlets (such as HuffPo, MSNBC, etc.), tabloid press, and social media:

One: When I am sick for more than a month and on medication (multiple rounds of steroids), the accusation is that because my face looks puffy, I have “clearly had work done,” with otherwise credible reporters with great bravo “identifying” precisely the procedures I allegedly have had done.

Two: When my skin is nearly flawless, and at age 43, I do not yet have visible wrinkles that can be seen on television, I have had “work done,” with media outlets bolstered by consulting with plastic surgeons I have never met who “conclude” what procedures I have “clearly” had. (Notice that this is a “back-handed compliment,” too—I look so good! It simply cannot possibly be real!)

Three: When my 2012 face looks different than it did when I filmed Double Jeopardy in 1998, I am accused of having “messed up” my face (polite language here, the F word is being used more often), with a passionate lament that “Ashley has lost her familiar beauty audiences loved her for.”

Four: When I have gained weight, going from my usual size two/four to a six/eight after a lazy six months of not exercising, and that weight gain shows in my face and arms, I am a “cow” and a “pig” and I “better watch out” because my husband “is looking for his second wife.” (Did you catch how this one engenders competition and fear between women? How it also suggests that my husband values me based only on my physical appearance? Classic sexism. We won’t even address how extraordinary it is that a size eight would be heckled as “fat.”)

Ashley Judd on her new show “Missing”

Five: In perhaps the coup de grace, when I am acting in a dramatic scene in Missing—the plot stating I am emotionally distressed and have been awake and on the run for days—viewers remarks ranged from “What the f–k did she do to her face?” to cautionary gloating, “Ladies, look at the work!” Footage from “Missing” obviously dates prior to March, and the remarks about how I look while playing a character powerfully illustrate the contagious and vicious nature of the conversation. The accusations and lies, introduced to the public, now apply to me as a woman across space and time; to me as any woman and to me as every woman.

That women are joining in the ongoing disassembling of my appearance is salient. Patriarchy is not men. Patriarchy is a system in which both women and men participate. It privileges, inter alia, the interests of boys and men over the bodily integrity, autonomy, and dignity of girls and women. It is subtle, insidious, and never more dangerous than when women passionately deny that they themselves are engaging in it. This abnormal obsession with women’s faces and bodies has become so normal that we (I include myself at times—I absolutely fall for it still) have internalized patriarchy almost seamlessly. We are unable at times to identify ourselves as our own denigrating abusers, or as abusing other girls and women.

A case in point is that this conversation was initially promulgated largely by women; a sad and disturbing fact. (That they are professional friends of mine, and know my character and values, is an additional betrayal.)

That the conversation about my face was initially promulgated largely by women is a sad and disturbing fact.

News outlets with whom I do serious work, such as publishing op-eds about preventing HIV, empowering poor youth worldwide, and conflict mineral mining in Democratic Republic of Congo, all ran this “story” without checking with my office first for verification, or offering me the dignity of the opportunity to comment. It’s an indictment of them that they would even consider the content printable, and that they, too, without using time-honored journalistic standards, would perpetuate with un-edifying delight such blatantly gendered, ageist, and mean-spirited content.

Ashley Judd responds to her critics on ‘Nightly News.’

I hope the sharing of my thoughts can generate a new conversation: Why was a puffy face cause for such a conversation in the first place? How, and why, did people participate? If not in the conversation about me, in parallel ones about women in your sphere? What is the gloating about? What is the condemnation about? What is the self-righteous alleged “all knowing” stance of the media about? How does this symbolize constraints on girls and women, and encroach on our right to be simply as we are, at any given moment? How can we as individuals in our private lives make adjustments that support us in shedding unconscious actions, internalized beliefs, and fears about our worthiness, that perpetuate such meanness? What can we do as families, as groups of friends? Is what girls and women can do different from what boys and men can do? What does this have to do with how women are treated in the workplace?

I ask especially how we can leverage strong female-to-female alliances to confront and change that there is no winning here as women. It doesn’t actually matter if we are aging naturally, or resorting to surgical assistance. We experience brutal criticism. The dialogue is constructed so that our bodies are a source of speculation, ridicule, and invalidation, as if they belong to others—and in my case, to the actual public. (I am also aware that inevitably some will comment that because I am a creative person, I have abdicated my right to a distinction between my public and private selves, an additional, albeit related, track of highly distorted thinking that will have to be addressed at another time).

If this conversation about me is going to be had, I will do my part to insist that it is a feminist one, because it has been misogynistic from the start. Who makes the fantastic leap from being sick, or gaining some weight over the winter, to a conclusion of plastic surgery? Our culture, that’s who. The insanity has to stop, because as focused on me as it appears to have been, it is about all girls and women. In fact, it’s about boys and men, too, who are equally objectified and ridiculed, according to heteronormative definitions of masculinity that deny the full and dynamic range of their personhood. It affects each and every one of us, in multiple and nefarious ways: our self-image, how we show up in our relationships and at work, our sense of our worth, value, and potential as human beings. Join in—and help change—the Conversation.

Ashley Judd is a prolific actress, who will next be seen in ABC’s new midseason show, Missing. Judd most recently appeared in Dolphin Tale alongside Morgan Freeman, Harry Connick Jr. and Kris Kristofferson.

Judd is also on the board of directors for PSI (Population Services International), which she joined in 2004 after serving as Global Ambassador for PSI’s HIV education and prevention program, YouthAIDS since 2002. Judd has visited PSI programs in Thailand, Cambodia, Madagascar, Kenya, South Africa, Guatemala, Honduras, Nicaragua, El Salvador, India, Rwanda and the Democratic Republic of Congo. In her work, she witnesses the lives of the exploited and poor to help educated the world about the reality of global poverty and bring solutions to the devastating effects of social injustice and gender inequality.

Judd was the subject of three award-winning documentaries aired in more than 150 countries worldwide on VH1, The Discovery Channel and The National Geographic Channel. In her role as PSI board member, Judd has graced the covers of countless magazines and been the subject of newspaper and television interviews bringing vital awareness to issues closest to her heart, gender inequality and poverty alleviation.

Judd has visited legislators on Capitol Hill, addressed the General Assembly of the UN on the scourge human trafficking, spoke at the National Press Club, testified before the Senate Foreign Relations Committee for the protection of vulnerable women from violence, sexual abuse and HIV and, most recently served as an expert panelist at Clinton Global Initiative to discuss the issue of safe water and the empowerment of girls in the developing world.

Recently, Judd has come on board as a spokesperson for organizations Defenders for Wildlife and The Sierra Club providing her time and voice to advocate against practices of aerial wolf hunting (Defenders for Wildlife) and mountaintop removal coal mining (The Sierra Club).

She resides in Tennessee and Scotland with her husband, the international racing star Dario Franchitti. They have 8 beloved pets and enjoy a quiet, rural life.

New research by scientists at the University of Cambridge suggests that the neurotransmitter serotonin, which acts as a chemical messenger between nerve cells, plays a critical role in regulating emotions such as aggression during social decision-making.

Serotonin has long been associated with social behavior, but its precise involvement in impulsive aggression has been controversial. Though many have hypothesised the link between serotonin and impulsivity, this is one of the first studies to show a causal link between the two. The research also provides insight into clinical disorders characterized by low serotonin levels, such as depression and obsessive compulsive disorder (OCD), and may help explain some of the social difficulties associated with these disorders.

These findings highlight why some of us may become combative or aggressive when we haven’t eaten.The only way to build serotonin in the brain is by consuming tryptophan in our diet, through foods such as poultry or chocolate. Serotonin levels are lower when a person has not eaten. Since serotonin levels naturally decline when we don’t eat, the researchers took advantage of this effect in designing their experiment.

The researchers were able reduce brain serotonin levels in healthy volunteers for a short time by manipulating their diet.

They used a situation known as the ‘Ultimatum Game’ to investigate how individuals with low serotonin react to what they perceive as unfair behaviour. In this game one player proposes a way to split a sum of money with a partner. If the partner accepts, both players are paid accordingly. But if he rejects the offer, neither player is paid.

Normally, people tend to reject about half of all offers less than 20-30% of the total stake, despite the fact that this means they receive nothing – but rejection rates increased to more than 80% after serotonin reductions.

Other measures showed that the volunteers with serotonin depletion were not simply depressed or hypersensitive to lost rewards.

These results suggest that serotonin plays a role in social decision making.

Normally, serotonin keeps aggressive social responses in check.

Changes in diet and stress cause fluctuations in serotonin levels, and this study suggests that the fluctuations in serotonin affect every day decision-making

This study suggests that patients with depression and anxiety disorders may benefit from therapies that teach them strategies for regulating emotions during decision making, particularly in social scenarios.

This research was funded by the Wellcome Trust and the Medical Research Council.

ANDREW AVRIN sits on a beige couch in a nondescript room, a fruit still-life partly visible on the wall behind him, twisting his fingers while, off-camera, an unseen interviewer prompts him to talk about his sister, Melissa, who died at the age of 19 after a long battle with bulimia.

“There was no food in the house,” he says, looking off to the side as his eyes fill. “If I went out with friends, I could not bring leftovers home because they would be gone by the next morning.”

Once, he explains, in the middle of a bitterly cold night, he looked out the window and saw Melissa on the curb, going through the garbage. “I went outside and I yelled her name,” he recounts in the interview, his voice breaking. “Just the way she looked back at me — it was so empty, vacant. It was a deer in the headlights, but that doesn’t even explain it.”

It is a hard scene for anyone to watch, but even more so for the film’s producer — Judy Avrin, Melissa’s mother, who decided to make a documentary about her daughter’s life and, ultimately, her death.

People deal with grief in their own ways, and those who have been spared the loss of a daughter or a son can only imagine how they would choose to try to cope. For Ms. Avrin, coping meant confronting her anguish and trying to make something good come out of it.

The idea for a film didn’t occur to her immediately. In the weeks following Melissa’s death, Ms. Avrin mostly avoided her daughter’s bedroom, and tried to resume some semblance of normalcy, going back to work three days a week as the coordinator for a consortium of academic libraries in New Jersey. But one day she sat down to read Melissa’s leather-bound journal.

Someday …

I’ll eat breakfast.

I’ll keep a job for more than 3 weeks.

I’ll have a boyfriend for more than 10 days.

I’ll love someone.

I’ll travel wherever I want.

I’ll make my family proud.

I’ll make a movie that changes lives.

The film, called “Someday Melissa” and now in the editing stages, has become for Ms. Avrin salve, distraction and cause — a way to get the word out to other families grappling with eating disorders that they are not alone; to sound the alarm that eating disorders have the highest mortality rate of any mental illness; to help make sense of the senseless event that was losing her teenage daughter.

“I kept saying, ‘This is an amazing way for me to channel my grief,’ ” Ms. Avrin said. “But it also allowed me to put off grieving.”

Ms. Avrin, 56, got the idea for the film from one of Melissa’s therapists, Danna Markson, who introduced her to Jeffrey Cobelli, 27, a filmmaker. Over the last several months of working on the project, Ms. Avrin has come to know more than she ever intended to about eating disorders — how their seriousness has been underestimated, their treatment underinsured, their deaths underreported.

The process hasn’t been easy, and some, like her ex-husband, initially questioned the impulse to do it at all. Melissa’s best friend since first grade, Nicole Kendrick, who also suffers from an eating disorder, said she was incredulous when she first learned that Ms. Avrin was making the film. “I thought she was crazy,” Ms. Kendrick said. “I guess I didn’t realize how deep a mother’s love can run.”

But Ms. Avrin said that making the film has been easier than doing nothing at all. “I’ve never once thought this was more than I could bear,” she said, in an interview at her home in Totowa, N.J. “If anything, the more I continue, the more I know it’s the right thing to do.”

The difficulty of reliving her daughter’s decline has been mitigated by the public response. “Sometimes I think: ‘I’m a suburban mom. Who am I to think I could make a difference in the world?’ ” Ms. Avrin said. “But then I read the messages that keep coming in from people I know and people I don’t know who say Melissa’s story has motivated them to fight one more day.”

On Melissa’s Facebook page and on the film’s Web site — somedaymelissa.com — Ms. Avrin continues to get feedback. “Thank you,” says one entry posted on the Web site’s guestbook page. “This could save one person’s life. That life may be mine.”

Ms. Avrin and Mr. Cobelli have interviewed Melissa’s family members, doctors and friends, along with prominent experts in the field, like Dr. Thomas R. Insel, the director of the National Institute of Mental Health; and Dr. B. Timothy Walsh, the founding director of the Eating Disorders Research Unit at the New York State Psychiatric Institute, and Dr. Evelyn Attia, the director of the Columbia Center for Eating Disorders, both at Columbia University Medical Center.

“I get a lot of requests, but there was something about this one I thought was particularly striking,” said Dr. Insel of the mental health institute. “I wanted to hear more of the story.”

“It was such an extraordinary expression of love,” he said, “a powerful way of honoring and remembering the daughter she lost.”

Although those closest to Melissa agreed to be interviewed for the film, participating wasn’t easy. William Avrin, Melissa’s father, said that he might have preferred to keep his experience to himself and that he was in no hurry to revisit his memories of Melissa. “I have a hole in my heart and it will be there forever,” he said in a telephone interview. “I don’t really try to describe what it’s like to lose a child.”

But he felt he had to do it for the film. “Clearly, Judy’s a champion of this project,” he said. “I’m a little bit more personal and inward. I’m still struggling with the whole thing. This is her way of dealing with it, and I respect that.”

In the documentary interview, filmed at his home in Hamburg, N.J., Mr. Avrin visibly struggles to describe what it was like to be thousands of miles away in Japan on business when he found out his daughter had died. At first he appears almost devoid of emotion, delivering his words in flat, deliberative sentences as he sits in a blue button-down shirt in front of his fireplace mantel. But then you can see tears trickling down into his salt-and-pepper mustache. “What was I thinking?” he says, repeating the question. “I was thinking my daughter is dead. That’s not supposed to happen. I couldn’t believe it. I didn’t — didn’t know what to think. I was in shock.”

Upon returning from Japan, Mr. Avrin decided not to view his daughter’s body. “Judy thought it would be better if I didn’t,” he said, “that I’d remember her like the last time that I saw her.”

Melissa died on May 6, 2009. Cause of death: heart attack due to complications from an eating disorder. Just a few days before, Melissa learned she had been admitted to Emerson College. The official letter of acceptance arrived a week after she died and sits unopened.

Melissa’s brother, Andrew, who is completing his Master of Science degree in engineering, said he believes the documentary has become essential to his mother’s emotional resilience. “It’s the only way she knows how to move forward,” he said.

At the same time, Andrew said he worried that the documentary would ultimately prove to be just a Band-Aid, postponing the heartbreak that is bound to rear its head when the film is completed. “The trick becomes moving forward with life but not letting everything this project is fill the void completely,” he said, “so the second this project finishes, you don’t crash.”

To be sure, Ms. Avrin doesn’t always hold it together. She did not conduct the interviews with her ex-husband or with her son (her collaborator, Mr. Cobelli, did). “We would have just sat there and cried,” she said.

In the interviews she did do, there have been times when she has broken down during or afterward. In concluding her discussion with Dr. Leslie Sanders, one of Melissa’s doctors, for example, Ms. Avrin starts to cry, and the cameras keep rolling. “I still remember being in your office and — I think her potassium was off — and you said, ‘I’ll be your quarterback,’ ” Ms. Avrin tells Dr. Sanders. “I didn’t know who to turn to next and I felt like I was in such good hands with you.”

Dr. Sanders responds: “I think what I remember about that first visit is just being struck at how little her life had become — I think at that point she was barely in school — and how much she was struggling, not just physically, I think physically was the least of it, but just emotionally and how we needed to do something intensive, and quickly, to get her life back.”

BORN Dec. 21, 1989, Melissa seemed in her early years to be a happy little girl. Her family lived in Wayne, N.J., and then in Pine Brook, N.J., spending two years in Coral Gables, Fla., in between, where Mr. Avrin was transferred for his work with a specialty chemical company. Melissa did well in school — producing A’s and short stories.

But at age 13, thing started to change. Melissa’s mood darkened; she didn’t want to go to school or do extracurricular activities. She developed stomach problems and constipation. Ms. Avrin took her to a pediatric gastroenterologist who said Melissa probably had an eating disorder. “I reacted the way most parents do: ‘That’s not possible,’ ” Ms. Avrin said. “We didn’t go back to him.”

In the early stages, the Avrins did not really see what was going on, in part because Melissa wasn’t visibly underweight, in part because they didn’t want to. But clues started to show up that were too stark to ignore — logs of cookie dough that disappeared from the freezer along with whole boxes of cookies from the cabinet. Empty pizza boxes. “I found containers with chewed and spit-out food and I’d never heard of that before,” Ms. Avrin tells Dr. Sanders during their filmed interview. “Is that very common?”

Ms. Avrin wrapped the fridge in locks and chains, hid her purse and made sure never to leave money lying around. “It didn’t have to be good junk food — if she wanted to go on a binge, it could be a dozen eggs,” Ms. Avrin said of Melissa. “Anything that wasn’t nailed down, she would eat.”

Ms. Kendrick, in her own interview for the film, alternates between smiling recollections of her childhood friend and sad eyes as she recalls Melissa’s downward spiral. “People who knew her in the last two years never really saw who she really was,” she says. “She was so energetic and funny and just ridiculous but not, like, in an obnoxious way. And then, as she started to worry about what other people thought, that’s when it started to be in more of an attention-getting way. When things got really bad, that kind of all just slowly disappeared and it just became very monotone — down. And we didn’t really see that energetic, fun Melissa anymore.”

Eventually, Melissa was sent away for professional help against her will and thus began a series of programs over the next few years that had varying degrees of success. It wasn’t until Melissa’s third round of in-patient treatment — when she and other young women testified about their eating disorders in front of their families — that her father began to fully understand. “I really said, ‘Wow this is almost like heroin addiction,’ ” he says in his film interview. “They need to purge because it makes them feel high and it’s something they need to do. I never appreciated that.”

In the course of making the film, Ms. Avrin has become something of a public service announcement on eating disorders. She was a featured speaker last October at the first walk to raise money for the National Eating Disorders Association. At its benefit dinner in March in New York, the evening opened with a clip from Ms. Avrin’s film. She is due to be in Washington in late April to lobby Congress as part of an Eating Disorders Coalition.

She said she is happy to play the role of advocate, to help try to remove the stigma that still cloaks eating disorders and keeps people from acknowledging the disease as the cause of death in obituaries. “I want it to come out of the shadows,” Ms. Avrin said. “I want people to talk about it, for people to get treatment faster, to reach doctors on the front lines. I want parents to open their eyes and not be swayed by being glad that their kid fits into size 4 jeans — to stop focusing on looks.”

Ms. Avrin is aiming to finish her documentary project by June, in time for summer film festival deadlines, and she said she is determined to get theatrical distribution. It would seem the ultimate act of acceptance. Yet in her film interview with Dr. Sanders, Ms. Avrin sounds like a mother still wrestling with remnants of denial.

“I’ve always been the glass half-full — I’ve always been an optimist,” she says, reaching under her eyeglasses to wipe away tears. “I always believed that she really would be somebody who could recover, even though, looking back, I realized the odds were stacked against her because of the level of her illness.”

“But I never lost hope and, you know,” she adds, “I still believe that she could have beaten it.”

Although we don’t exactly shout it from the rooftop, my family never has hidden the experience of our middle daughter’s struggle with anorexia nervosa, the eating disorder that leads some people — and especially smart and pretty young women — to starve themselves.

Very often, the conversation produces a flash of understanding.

There was the baseball executive. The City Council member back in Wisconsin. The fellow parishioner. The neighbor. The casual professional acquaintance.

All had firsthand experiences with eating disorders.

Surprised? You shouldn’t be.

After all, the theme of National Eating Disorders Awareness Week, to be held Feb. 26 to March 3, is “Everybody Knows Somebody.”

Lynn Grefe, president of the National Eating Disorders Association, pegs the number of Americans battling a form of the illness — anorexia or one of its evil cousins, bulimia or binge eating disorder — at 24 million, a figure that dwarfs the number of those suffering from, for example, Alzheimer’s disease, estimated at about 5.4 million in 2011.

To put it simply, that means sufferers are prone to bouncing pinball-fashion from anorexia to bingeing to bulimia.

Here’s one more fact to make you shiver: The mortality rate for eating disorders is higher than for any other mental illness, with death typically resulting from medical complications or suicide. And anorexic patients remain at higher risk for premature death for years after treatment.

One key to reducing the awful toll is to raise public awareness. Ignorance of eating disorders, their warning signs and their long-term effects is widespread. Teachers, coaches, physicians and plenty of others who ought to know, don’t

And that brings me to Daughter No. 3, a clever and articulate lass named Jane, who was required by circumstances beyond her control to transfer to Columbus North High School before her senior year. With the change of schools, of course, came the requirement that she produce a senior project.

Almost on the fly, Jane decided to draw a positive result from the experience of her sister’s illness and make eating disorder awareness the focus of her project.

One result of her work will be on display at 6:30 p.m. Feb. 16 at Bartholomew County Public Library, where Jane will screen a documentary called “Someday Melissa,” the story of Melissa Avrin, a New Jersey woman who died three years ago at 19 after a grueling battle with bulimia. The movie was produced by Melissa’s mom, who resolved to make something good come out of her daughter’s death.

The documentary will be followed by a question-and-answer session with a representative of the Coalition for Overcoming Problem Eating at Indiana University in Bloomington.

I suppose I shouldn’t be surprised by Jane’s choice of topic. The two sisters are best friends — except, of course, when they’re mortal enemies. They’re very different, but their bond is unbreakable.

Her sister’s ordeal has been a significant influence on Jane’s teenage years. Like alcoholism, eating disorders distort family routines nearly beyond recognition as the illness exerts a centripetal force that draws all things to it.

Life in a household struggling with an eating disorder can be isolating. After all, who else understands that for the sufferer, “dinner” can be a few strands of chicken breast and a lettuce leaf?

Let me rephrase that. It was isolating — until it became clear just how many families out there have dealt with the same thing.

That’s why I’m writing today. If an eating disorder has wrapped itself around someone you love — or if you simply want to learn more — head to the library on the 16th.

A six-week hospital stay provided Daughter No. 2 some valuable tools for coping with her illness, though eating remains a high-anxiety endeavor. A sharp, sympathetic therapist in Bloomington has made a difference. Still, you can’t wave a magic wand to make an eating disorder vanish.

If you know what I mean, we should talk.

Mark Baldwin is editor of The Republic, Columbus Indiana which is where this post was published. You can reach Mr. Baldwin at 379-5665 or by email at mbaldwin@therepublic.com. Follow him on Twitter @MarkFBaldwin.

Eating disorders are frequently seen as psychological or societal diseases, but do they have an underlying biological cause? A new study shows that the levels of a brain protein differ between healthy and anorexic women.

Anorexia is a serious and potentially fatal eating disorder most commonly affecting women. Scientists do not yet understand the physical causes of anorexia, though some studies suggest a link to low levels of a brain protein called BDNF. BDNF stands for brain derived neurotrophic factor. This molecule, found in the brain’s fear hub could have a significant impact on the study of several anxiety disorders including Post Traumatic Stress Disorder, as well as on anorexia and bulimia.

Now, a study recommended by psychiatrist Cindy Bulik, founder and director of the UNC Eating Disorders Program shows that BDNF levels are higher in women who have recovered from anorexia. This suggests that low BDNF levels may be reversible.

Researchers at Chiba University in Japan found that anorexic women had lower levels of BDNF in their blood than healthy women or those who had recovered from anorexia. Women with low BDNF also had the lowest self-image, suffered from anxiety and depression, and performed poorly on certain tests of cognitive ability.

Further study is needed to determine what role BDNF plays in anorexia, and if it can be used to predict the risk of developing it, but Bulik forecasts that “…BDNF may emerge as a useful biomarker of [anorexia] and of recovery from [anorexia].